Provider Demographics
NPI:1093110827
Name:WEIRICH, JENNIFER D (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:WEIRICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 W. RAND ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-618-5450
Mailing Address - Fax:847-618-5459
Practice Address - Street 1:199 W. RAND ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:847-618-5450
Practice Address - Fax:847-618-5459
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2014-0077363A00000X
IL085005639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant